CalREDIE Help issues a username and password for Secure File Transfer (SFT) in support of 90 days of initial ELR message testing. Testing beyond this 90 day period or going to production requires that the submitter provide a SSH public key to CalREDIE Help. Public keys may last for a duration up to two years. Using a key or a password after expiration results in a locked account. If your SFT account is locked or you cannot access your SFT account, please contact CalREDIE Help for assistance.

Q. What is an OID and why is it needed?

OIDs are Object Identifiers; they are used to identify the coding systems for coded elements, to identify assigning authorities, data systems, etc. However, for ELR, they are used to identify the organizations involved in sending and receiving ELR as well as the systems sending and receiving ELR. CalREDIE (ELR receiving application) OID: 2.16.840.1.114222.4.3.3.10.1.1 and CDPH CID (Center for Infectious Disease) (ELR receiving organization) is assigned the OID: 2.16.840.1.114222.4.1.214104. If your organization needs assistance with OIDs, please consult CDC at PHINTECH@cdc.gov.

Q. Where can submitters find more technical information on message requirements for ELR?

Submitters must follow the HL7 Version 2.5.1 ORU^R01 ELR2PH Implementation Guide (US Realm) which is available for purchase from HL7.org (Please Note: Implementers must have an institutional membership in HL7 and have available a legal copy of this guide before implementing the message in order to be in compliance with federal copyright laws). The CalREDIE ELR Companion Guide should also be used to further refine messages to achieve California compliance.

Q. Are submitters required to send standard codes (LOINC and SNOMED)?

Yes, LOINC and SNOMED standard codes are required. Optionally, local codes may be included along with standard codes. Local codes will not be accepted in the absence of standard codes with the exception of an emerging condition for which there is no LOINC or SNOMED code. In addition to the LOINC and SNOMED codes used for test requests and results, other coded elements are used throughout the message. The sources for those codes are referenced in the HL7 guide as well as in the CalREDIE ELR Companion Guide. Many of them require the use of associated OID values that will be found in the HL7 guide and in PHVS value sets provided through CDC PHINVADS or available through the CalREDIE team.

Q. Can CDPH accept local codes?

CDPH can accept local codes in lieu of standard codes only when there is an emerging disease for which a LOINC and/or SNOMED code does not exist. Local codes will not be accepted in the absence of standard codes with the exception of an emerging condition for which there is no LOINC or SNOMED code yet available. Local codes may be included with LOINC and SNOMED codes.

Q. What message format is required?

CDPH accepts only HL7 version 2.5.1 ORU^R01 ELR2PH messages based on the US Realm ELR Implementation Guide, with additional constraints listed in the CalREDIE ELR Companion Guide. Please refer to question 2 for further information.

Q. Does CDPH accept batch messaging?

CalREDIE ELR is now able to accept batch ELR messages.

Q. Does a submitter require an Object Identifier (OID)?

Each submitter requires an OID. Each sending application (information system) requires an OID.

Q. Does a submitter require a CLIA number?

Each lab requires its own CLIA number in order to submit ELR to CalREDIE.

Q. Does each lab have to report individually?

This is an individual reporting structure. It is not required that each lab reports individually.

Q. Can one entity send ELR for two or more labs?

This is a group reporting structure. One reporting entity can report for an unlimited number of labs. This requires the reporting entity to provide one OID for itself plus each lab's CLIA number.

Q. Will submitters receive receipts? How are message acknowledgements sent to the submitter?

HL7 standards provide for either acknowledgement (ACK) or negative acknowledgement (NAK). Negative acknowledgement (NAK) will contain a description of issues with the original message, including errors, omissions, and other items requiring correction and resubmission. CDPH automatically provides message acknowledgements to the submitter through the Secure File Transfer service.

Q. How can submitters address Meaningful Use (MU) measures? Where can submitters find more Meaningful Use information?

Submitting ELR may allow eligible hospitals to meet the ELR measure of Meaningful Use (MU). While meeting Meaningful Use is not the primary goal of the CDPH ELR system, submitters complying with public health electronic lab reporting requirements may concurrently meet requirements for the Meaningful Use measure relating to ELR. Please consult with the Office of National Coordinator (ONC) or Centers for Medicare and Medicaid (CMS) for more information on Meaningful Use.

Q. Which diseases and codes should be reported to via CalREDIE ELR?

Any submitter should start with the California list (Title 17 Section 2505) to find the list of reportable lab results. Cross the Section 2505 list against your facility's test catalog. The intersection of those two lists will result in the list of reportable disease results that your facility would expect to send. Take each of those reportable diseases and extract the pertinent LOINC and SNOMED codes from RCMT. That will result in the list of codes that your facility can expect to send.

Q. Can submitters send HIV lab reports via ELR?

At this time, our policy does not support ELR regarding HIV. Submitters must code their system logic to refrain from sending ELRs regarding HIV. Additionally, our safeguards programmatically refuse HIV lab reports by LOINC and SNOMED codes.

Q. Our installed EHR is certified and it has built-in ELR capabilities/features. Can we just start sending ELR?

No. It is first necessary to complete a validation process that starts with sending sample messages generated by your EHR system to the CalREDIE Team for review and validation. Once the validation process has been successfully completed and your messages can be shown to be consumed by the CalREDIE system, then you will be considered as ready to begin sending actual lab reports. Also, ELR capabilities vary significantly between EHR products. Most submitters will need a health information integration engine (middleware), or other locally developed interface between the EHR and the secure connection to public health reporting. Sending HL7 2.5.1 ORU^R01 ELR2PH messages to public health may require conditional trigger logic as well as adjustments and refinements to the message syntax that are implemented in the integration engine.

Q. Where do ELRs go?

ELRs are routed from the intake process, through CalREDIE, to your jurisdiction's Disease Incident Staging Area.

Q. Is programmatic handling of certain diseases set up to take action X, Y, Z without human interaction?

Programmatic handling is available, and it is under discussion with all CalREDIE stakeholders, but it is not activated at this point.

Q. How do we address Meaningful Use (MU) questions?

Submitting ELR may allow eligible hospitals to meet the ELR measure of Meaningful Use (MU). Please see the Office of National Coordinator (ONC) and Centers for Medicare and Medicaid (CMS) Meaningful Use pages for more Meaningful Use information.

Q. My jurisdiction does not participate in CalREDIE. What happens to ELRs pertaining to patients in my jurisdiction?

This item is under discussion.

Q. Why can't submitters send HIV lab reports via ELR?

At this time, our policy does not support ELR regarding HIV. Submitters must code their system logic to refrain from sending ELRs regarding HIV. Additionally, our safeguards programmatically refuse HIV lab reports by LOINC and SNOMED codes.